The health impacts of ambient air pollution in Australia: A systematic literature review

Volunteerism Addressing Environmental Disparities in Allergy (VAEDIA): The presidential initiative to combat environmental injustice in allergy and immunology-a Work Group Report of the AAAAI VAEDIA task force

Many vulnerable people lose their health or lives each year as a result of unhealthy environmental conditions that perpetuate medical conditions within the scope of allergy and immunology specialists' expertise. While detrimental environmental factors impact all humans globally, the effect is disproportionately more profound in impoverished neighborhoods. Environmental injustice is the inequitable exposure of disadvantaged populations to environmental hazards. Professional medical organizations such as the American Academy of Allergy, Asthma & Immunology (AAAAI) are well positioned to engage and encourage community outreach volunteer programs to combat environmental justice. Here we discuss how environmental injustices and climate change impacts allergic diseases among vulnerable populations. We discuss pathways allergists/immunologists can use to contribute to addressing environmental determinants by providing volunteer clinical service, education, and advocacy. Furthermore, allergists/immunologists can play a role in building trust within these communities, partnering with other patient advocacy nonprofit stakeholders, and engaging with local, state, national, and international nongovernmental organizations, faith-based organizations, and governments. The AAAAI's Volunteerism Addressing Environmental Disparities in Allergy (VAEDIA) is the presidential task force aiming to promote volunteer initiatives by creating platforms for discussion and collaboration and by funding community-based projects to address environmental injustice.

Effect of ambient ozone pollution on disease burden globally: A systematic analysis for the global burden of disease study 2019

BACKGROUND

Exposure to ambient ozone pollution causes health loss and even death, and both are the main risk factors for the disease burden worldwide. We comprehensively evaluated the ozone pollution-related disease burden.

METHODS

First, numbers and age-standardized rates of deaths and disability-adjusted life years (DALYs) were assessed globally and by sub-types in 2019. Furthermore, the temporal trend of the disease burden was explored by the linear regression model from 1990 to 2019. The cluster analysis was used to evaluate the changing pattern of related disease burden across Global Burden of Disease Study (GBD) regions. Finally, the age-period-cohort (APC) model and the Bayesian age-period-cohort (BAPC) model were used to predict the future disease burden in the next 25 years.

RESULT

Exposure to ozone pollution contributed to 365,222 deaths and 6,210,145 DALYs globally in 2019, which accounted for 0.65 % of deaths globally and 0.24 % of DALYs globally. The disease burden was consistently increasing with age. Males were high-risk populations and low-middle socio-demographic index (SDI) regions were high-risk areas. The disease burden of ozone pollution varied considerably across the GBD regions and the countries. In 2019, the number of deaths and DALYs cases increased by 76.11 % and 56.37 %, respectively compared to those in 1990. The predicted results showed that the number of deaths cases and DALYs cases for both genders would still increase from 2020 to 2044.

CONCLUSION

In conclusion, ambient ozone pollution has threatened public health globally. More proactive and effective strategic measures should be developed after considering global-specific circumstances.

Ambient dust pollution with all-cause, cardiovascular and respiratory mortality: A systematic review and meta-analysis

A severe health crisis has been well-documented regarding dust particle exposure. We aimed to present the risk of all-cause, cardiovascular, and respiratory mortality due to particulate matter (PM) exposure during non-dust and dust storm events by performing a meta-analysis. A systematic review of the literature was conducted by an online search of the databases (Google Scholar, Web of Science, Scopus, and PubMed) with no restrictions according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines until December 2022. We performed a random-effects model to compute the pooled rate ratio (RR) of mortality with 95 % confidence intervals (CI). The Office of Health Assessment and Translation (OHAT) risk of bias rating tool was prepared to assess the quality of the individual study. The registration number in PROSPERO was CRD42023423212. We found a 16 % (95 % CI: 0.7 %, 24 %) increase in all-cause, 25 % (95 % CI: 14 %, 37 %) increase in cardiovascular, and 18 % (95 % CI: 13 %, 22 %) increase in respiratory mortality per 10 μg/m3 increment in dust exposure. Furthermore, the RRs per 10 μg/m3 increment in PM10-2.5 were 1.046 (95 % CI: 1.019, 1.072)¸ 1.085 (95 % CI: 1.045, 1.0124), and 1.089 (95 % CI: 0.939, 1.24) for all-cause, cardiovascular, and respiratory mortality, respectively. PM10 during dust days significantly increased the all-cause (1.013, 95 % CI: 1.007, 1.018) cardiovascular mortality risk (1.014, 95 % CI: 1.009, 1.02). We also found significant evidence for all-cause, cardiovascular, and respiratory mortality among females and the elderly age group due to dust particle (PM10-2.5 and PM10) exposure. Our results provided significant evidence about high concentrations of PM10-2.5 and PM10 during dust storm events related to mortality risk.

A Scoping Review of Urban Planning Decision Support Tools and Processes That Account for the Health, Environment, and Economic Benefits of Trees and Greenspace

Compelling evidence shows that trees and greenspaces positively impact human well-being and the environment and offer economic benefits. Nevertheless, there exists a knowledge gap regarding the extent to which this evidence is efficiently incorporated into existing urban planning decision-making processes. This scoping review identified the extent to which urban planning decision-making frameworks, models, and tools consider the health, environmental, and economic benefits of trees and greenspace. Out of 28 reviewed studies, 11 (39%) reported on frameworks, models, and tools that take into account the health, environmental, and economic dimensions of trees and greenspace. Additionally, seven studies provided comprehensive coverage of at least one of the three key dimensions. However, none of the decision support frameworks, models, or tools comprehensively integrated all three dimensions, with only two tools (7%) scoring above 50% (five or more out of nine) in terms of comprehensiveness. This review highlights the urgent need to incorporate the true economic and monetary values of the health and environmental benefits of trees and greenspace to inform urban development decision making.

Relationship between air pollutants and spontaneous abortion in a coal resource valley city: a retrospective cohort study

OBJECTIVE

Pollutants in the atmosphere have been linked to poor pregnancy outcomes in women. However, such investigations are scarce in metropolitan northern China. The major exposure window of air pollution affecting pregnant women is also unknown.

METHODS

For the analysis, this retrospective cohort study enrolled 6960 pregnant women recorded at Tongchuan People's Hospital from January 2018 to December 2019. Pollutant concentration values from the nearest monitoring station to the pregnant women were used to estimate exposure doses for each exposure window. Logistic regression models were created to investigate the connection between pollutants and spontaneous abortion while controlling for confounding factors.

RESULTS

PM2.5 was a risk factor for spontaneous abortion in T3 (30-60 days before the first day of the last menstrual period [LMP]), (OR: 1.305, 95% CI: 1.143-1.490) and T4 (60-90 days before the first day of the LMP),(OR: 1.450, 95% CI: 1.239-1.696) after controlling for covariates. In the same window, PM10 was a risk factor (OR: 1.308, 95% CI: 1.140-1.500), (OR: 1.386, 95% CI: 1.184-1.621). In T2 (30 days before the first day of the LMP), T3, and T4, SO2 was a risk factor for spontaneous abortion (OR: 1.185, 95% CI: 1.025-1.371), (OR: 1.219, 95% CI: 1.071-1.396), (OR: 1.202, 95% CI: 1.040-1.389). In T3 and T4, NO2 was a risk factor (OR: 1.171, 95% CI: 1.019- 1.346), (OR: 1.443, 95% CI: 1.259-1.655). In T1 (from the first day of the LMP to the date of abortion), O3 was found to be a risk factor (OR: 1.366, 95% CI: 1.226-1.521).

CONCLUSION

Exposure to high levels of air pollutants before and during pregnancy may be a risk factor for spontaneous abortion in pregnant women. This study further illustrates the importance of reducing air pollution emissions.

Acute air pollution and temperature exposure as independent and joint triggers of spontaneous preterm birth in New South Wales, Australia: a time-to-event analysis

Introduction

Exposure to high ambient temperatures and air pollution has been shown to increase the risk of spontaneous preterm birth (sPTB). Less clear are the effects of cold and the joint effects of air pollution and temperature.

Methods

Using a Cox proportional hazard regression model, we assessed the risk of independent and combined short-term exposure to ambient daily mean temperature and PM2.5 associated with sPTB in the last week before delivery on overall sPTB (weeks 23-36) and three subtypes: extremely sPTB, very sPTB, and moderate-to-late sPTB for a birth cohort of 1,318,570 births from Australia (Jan 2001-Dec 2019), while controlling for chronic exposure (i.e., throughout pregnancy except the last week before delivery) to PM2.5 and temperature. The temperature was modeled as a natural cubic spline, PM2.5 as a linear term, and the interaction effect was estimated using a multiplicative term. For short-term exposure to temperature hazard ratios reported are relative to the median temperature (18.1°C).

Results

Hazard ratios at low temperature [5th percentile(11.5°C)] were 0.95 (95% CI: 0.90, 1.00), 1.08 (95% CI: 0.84, 1.4), 0.87 (95% CI: 0.71, 1.06), and 1.00 (95% CI: 0.94, 1.06) and greater for high temperature [95th percentile (24.5°C)]: 1.22 (95% CI: 1.16, 1.28), 1.27 (95% CI: 1.03, 1.57), and 1.26 (95% CI: 1.05, 1.5) and 1.05 (1.00, 1.11), respectively, for overall, extremely, very, and moderate-to-late sPTBs. While chronic exposure to PM2.5 had adverse effects on sPTB, short-term exposure to PM2.5 appeared to have a negative association with all types of sPTB, with hazard ratios ranging from 0.86 (95th CI: 0.80, 0.94) to 0.98 (95th CI: 0.97, 1.00) per 5 μg/m3 increase in PM2.5.

Discussion

The risk of sPTB was found to increase following acute exposure to hot and cold ambient temperatures. Earlier sPTB subtypes seemed to be the most vulnerable. This study adds to the evidence that short-term exposure to ambient cold and heat and longer term gestational exposure to ambient PM2.5 are associated with an elevated risk of sPTB.

Greenness modifies the association between ambient air pollution and cognitive function in Australian adolescents, but not in mid-life adults

Exposure to ambient air pollution has been associated with reduced cognitive function in childhood and later life, with too few mid-life studies to draw conclusions. In contrast, residential greenness has been associated with enhanced cognitive function throughout the lifecourse. Here we examine the extent to which (1) ambient air pollution and residential greenness predict later cognitive function in adolescence and mid-life, and (2) greenness modifies air pollution-cognitive function associations.

PARTICIPANTS

6220 adolescents (51% male) and 2623 mid-life adults (96% mothers) from the Longitudinal Study of Australian Children.

MEASURES

Exposures: Annual average particulate matter <2.5 μm (PM_2.5), nitrogen dioxide (NO₂) and greenness (Normalised Difference Vegetation Index) for residential addresses from validated land-use regression models over a 10-13-year period.

OUTCOMES

Cognitive function from CogState tests of attention, working memory and executive function, dichotomised into poorer (worst quartile) versus not poor.

ANALYSES

Adjusted mixed-effects generalised linear models with residential greenness assessed as an effect modifier (high vs. low divided at median). The annual mean for PM_2.5 and NO₂ across exposure windows was 6.3-6.8 μg/m³, and 5.5-7.1 ppb, respectively. For adolescents, an IQR increment of NO₂ was associated with 19-24% increased odds of having poorer executive function across all time windows, while associations weren't observed between air pollution and other outcomes. For adults, high NO₂ predicted poorer cognitive function across all outcomes, while high PM_2.5 predicted poorer attention only. There was little evidence of associations between greenness and cognitive function in adjusted models for both generations. Interactions were found between residential greenness, air pollutants and cognitive function in adolescents, but not adults. The magnitude of effects was similar across generations and exposure windows. Findings highlight the potential benefits of cognitive health associated with the regulation of air pollution and urban planning strategies for increasing green spaces and vegetation.

Effect of ambient PM2.5 on healthcare utilisation for acute respiratory illness, Melbourne, Victoria, Australia, 2014-2019

Ambient particulate matter (PM_2.5) is an important component of natural and human-generated air pollution and a major contributor to the global burden of disease. Short-term effects of PM_2.5 exposure on respiratory illness have been described but most evidence arises from high pollution settings. We used case-crossover methods to estimate effects of outdoor PM_2.5 levels on emergency department (ED) presentations and hospital admissions for a range of acute respiratory illnesses and age groups in Melbourne, Australia from 2014-2019, with and without adjustment for other pollutants and weather conditions, using daily and one-week averaged lags. We estimated incidence rate ratios for a 10 μg/m³ increase in 7-day average ambient PM_2.5 of 1.043 (95% confidence interval (CI): 1.000-1.089) on ED presentation and 1.013 (95% CI: 0.971-1.056) on hospital admissions for acute respiratory illnesses for patients of any age. We observed distinct temporal patterns in daily lag effect by disease. The largest effects on acute lower respiratory tract infection and asthma were observed in children. Ambient PM_2.5 levels rarely exceeded standards in place at the time. Although uncertainty around most point estimates was relatively wide, these findings are most compatible with adverse health effects of ambient PM_2.5 at levels below currently established Australian national standards.Implications: Understanding the health impacts of air pollution is important for setting air quality targets, as well as for informing robust health system planning. Adverse effects of exposure to outdoor fine particulate matter on human respiratory health have been consistently described. However, most studies have been done in higher-pollution settings. Further, many studies have assessed health effects in broad categories such as all-cause respiratory mortality or hospitalization, and thus lack the granularity to inform detailed health service planning. Our study aimed to estimate effects of outdoor fine particulate matter on emergency department (ED) presentations and hospital admissions for a range of acute respiratory illnesses and age groups in Melbourne, Australia, a city with relatively good air quality by international comparison. Our study estimated consistent effects on both ED presentations and hospital admissions compatible with distinct patterns of adverse health effects at levels at or below established Australian national (and many international) standards. These results will help to inform both air quality policy and public health policy in similar settings.

Prenatal exposure to ambient air pollution and adverse birth outcomes: An umbrella review of 36 systematic reviews and meta-analyses

Multiple systematic reviews and meta-analyses linked prenatal exposure to ambient air pollutants to adverse birth outcomes with mixed findings, including results indicating positive, negative, and null associations across the pregnancy periods. The objective of this study was to systematically summarise systematic reviews and meta-analyses on air pollutants and birth outcomes to assess the overall epidemiological evidence. Systematic reviews with/without meta-analyses on the association between air pollutants (NO₂, CO, O₃, SO₂, PM_2.5, and PM₁₀) and birth outcomes (preterm birth; stillbirth; spontaneous abortion; birth weight; low birth weight, LBW; small-for-gestational-age) up to March 30, 2022 were included. We searched PubMed, CINAHL, Scopus, Medline, Embase, and the Web of Science Core Collection, systematic reviews repositories, grey literature databases, internet search engines, and references of included studies. The consistency in the directions of the effect estimates was classified as more consistent positive or negative, less consistent positive or negative, unclear, and consistently null. Next, the confidence in the direction was rated as either convincing, probable, limited-suggestive, or limited non-conclusive evidence. Final synthesis included 36 systematic reviews (21 with and 15 without meta-analyses) that contained 295 distinct primary studies. PM_2.5 showed more consistent positive associations than other pollutants. The positive exposure-outcome associations based on the entire pregnancy period were more consistent than trimester-specific exposure averages. For whole pregnancy exposure, a more consistent positive association was found for PM_2.5 and birth weight reductions, particulate matter and spontaneous abortion, and SO₂ and LBW. Other exposure-outcome associations mostly showed less consistent positive associations and few unclear directions of associations. Almost all associations showed probable evidence. The available evidence indicates plausible causal effects of criteria air pollutants on birth outcomes. To strengthen the evidence, more high-quality studies are required, particularly from understudied settings, such as low-and-middle-income countries. However, the current evidence may warrant the adoption of the precautionary principle.